Newborn Infant - Routine Examination Birthweight, gestational age and birthweight percentile are noted. General observation Of the baby's appearance, posture and movements provides valuable information about many abnormalities. The baby must be fully undressed during the examination. The head circumference is measured with a paper tape measure and its centile noted. This is a surrogate measure of brain size. The fontanelle and sutures are palpated. The fontanelle size is very variable. The sagittal suture is often separated and the coronal sutures may be overriding. A tense fontanelle when the baby is not crying may be due to raised intracranial pressure and cranial ultrasound should be performed to check for hydrocephalus. A tense fontanelle is also a late sign of meningitis. The face is observed. If abnormal, this may represent a syndrome, particularly if other anomalies are present. Down syndrome is the most common, but there are hundreds of syndromes. When the diagnosis is uncertain, a book or a computer database may be consulted and advice should be sought from a senior paediatrician or geneticist. If plethoric or pale, the haematocrit should be checked to identify polycythaemia or anaemia. Central cyanosis, which always needs urgent assessment, is best seen on the tongue. Jaundice within 24 h of birth requires further evaluation. The eyes are checked for red reflex with an ophthalmoscope. If absent, may be from cataracts, retinoblastoma and corneal opacity. This reflex is not present in infants with pigmented skin, but the retinal vessels can be visualised. The palate needs to be inspected, including posteriorly to exclude a posterior cleft palate, and palpated to detect an indentation of the posterior palate from a submucous cleft. Breathing and chest wall movement are observed for signs of respiratory distress. On auscultating the heart, the normal rate is 110-160 beats/min in term babies, but may drop to 85 beats/min during sleep. On palpating the abdomen, the liver normally extends 1—2 cm below the costal margin, the spleen tip may be palpable, as may the kidney on the left side. Any intra-abdominal masses, which are usually renal in origin, need further investigation. The femoral pulses are palpated. Their pulse pressure is: - reduced in coarctation of the aorta. This can be confirmed by measuring the blood pressure in the arms and legs - increased if there is a patent ductus arteriosus. The genitalia and anus are inspected on removing the nappy. Patency of the anus is confirmed. In boys, the presence of testes in the scrotum is checked by palpation. Muscle tone is assessed by observing limb movements. Most babies will support their head briefly when the trunk is held vertically. The whole of the back and spine is observed, looking for any midline defects of the skin. The hips are checked for developmental dysplasia of the hips (DDH). This is left until last as the procedure is uncomfortable. #Newborn #Infant #PhysicalExam #Examination #Peds #Pediatrics #Diagnosis
